NPIMap

Organization Active NPI

West Colonial Urgent Care

  • Emergency Medicine Physician
  • Orlando, FL
National Provider Identifier
1639613565
Registry record updated Dec 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
ME125820 Issued in FL
Legal business name
WEST COLONIAL URGENT CARE
Practice address
4220 W Colonial Dr
Suite 3
Orlando, FL 32808-8174
Phone
(407) 270-5124
Fax
(407) 270-5125
NPI assigned
Dec 12, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Srujani Gaddam, M.D.
Title
Medical Doctor
Phone
(407) 270-5124

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X ME125820 FL Primary

Addresses

Primary practice location

4220 W Colonial Dr
Suite 3
Orlando, FL 32808-8174

Mailing address

4220 W Colonial Dr
Suite 3
Orlando, FL 32808-8174
Phone (407) 270-5124

Other identifiers 1

IdentifierTypeStateIssuer
ME 125820OtherFLSTATE LICENSE

National Provider Directory

National Provider Directory

Locations

4220 W Colonial Dr
Ste 3
Orlando, FL 32808
Phone (407) 270-5124

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1481500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481500800000",
    "number": "1639613565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4220 W COLONIAL DR",
            "address_2": "SUITE 3",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328088174",
            "telephone_number": "407-270-5124",
            "fax_number": "407-270-5125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4220 W COLONIAL DR",
            "address_2": "SUITE 3",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328088174",
            "telephone_number": "407-270-5124",
            "fax_number": "407-270-5125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST COLONIAL URGENT CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-12",
        "last_updated": "2016-12-12",
        "status": "A",
        "authorized_official_last_name": "GADDAM",
        "authorized_official_first_name": "SRUJANI",
        "authorized_official_title_or_position": "MEDICAL DOCTOR",
        "authorized_official_telephone_number": "407-270-5124",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "ME125820",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "ME 125820",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.